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Now And Then: Health Care

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By TERENCE HUNT

The Associated Press

Published: March 29, 2009

THEN

EDITOR'S NOTE: This is an abridged version of a story that appeared in The Tampa Tribune's Sept. 23, 1993, editions, when President Bill Clinton introduced his health care reform package. Because of congressional battles, the plan remained in limbo and ultimately went nowhere. In March 1995, the Government Accounting Office estimated the Clinton administration spent about $10 million without reforming health care.

WASHINGTON - Proposing a top-to-bottom makeover of the nation's health care system, President Clinton called Wednesday night for ambitious reforms guaranteeing every American comprehensive medical benefits "that can never be taken away."

Clinton, in a speech to a nationally broadcast session of Congress, said his plan would reform "the costliest and most wasteful health care system on Earth without any new broad-based taxes."

"This health care system of ours is badly broken, and it is time to fix it," Clinton said.

Laying out his rationale for the biggest social initiative since the New Deal, Clinton said the current system is "too uncertain and too expensive, too bureaucratic and too wasteful. It has too much fraud and too much greed."

Pointing to his own proposal, which would require all employers to provide health insurance to their workers, the president said, "Let us guarantee every American comprehensive health benefits that can never be taken away."

Clinton said that under his plan, some Americans would be asked to pay more but that the vast majority would pay the same or less for health care coverage that would be the same or better than they currently have.

To help pay for it, Clinton said he would impose new taxes on tobacco but he dropped the idea of increases for beer, wine or hard liquor.

Clinton saluted his wife, Hillary, as "a talented navigator" for the controversial, complicated plan.

In a challenge to lawmakers, Clinton said, "Let us pledge tonight: before this Congress adjourns next year, you will pass and I will sign legislation to guarantee health security to every citizen of this country."

Clinton's speech set out six principles essential for any health plan: security, simplicity, quality, affordability, choice, and responsibility.

Health care costs are rising at more than twice the rate of other prices and represent one-seventh of all U.S. spending.

Clinton's plan for the first time would require all employers to pay 80 percent of the average health premium for their workers. Employees would pay the rest. Small businesses and low-income workers would get subsidies.

Giant insurance-purchasing pools called health alliances would be created in each state to negotiate with doctors, hospitals and insurers. Consumers would buy their coverage through the alliances.

The plan would vastly expand the government's power to control health costs if competition alone doesn't work. But critics question whether the controls would squeeze out quality, too.

Growth in the government's two biggest health programs, Medicare and Medicaid, would be slowed by $238 billion over five years, though many in Congress say it's politically unrealistic to cut that deeply on care for the elderly and the poor.

In the Republican response, South Carolina Gov. Carroll Campbell questioned how many jobs would be lost if small businesses were required to cover all workers. "Do you really want the federal government to control your health care?" Campbell asked.

Lonnie R. Bristow, chair of the 300,000-member American Medical Association's board of trustees, said "the means to finance reform are unclear and the timetable too aggressive. ... The president may be creating expectations that cannot be met."

Since 1912, when Theodore Roosevelt called for national health insurance, many attempts have been made to enact universal coverage. All of them failed.

This time, prospects appear better because Clinton is staking his presidency on the issue and taking a high-profile lead.

NOW

President Barack Obama's budget sets aside $634 billion over 10 years as a down payment on health care coverage for all, a goal that could ultimately cost $1 trillion or more.

Obama has outlined general policies, such as putting the country on a path to cover all its citizens and preserving the employer's role in providing health insurance. His budget also shows it will require tough choices on spending cuts and tax increases to pay for health care.

Sen. Max Baucus of Montana and Sen. Edward Kennedy of Massachusetts say they want to present legislation by the summer. Republicans are concerned about the costs and about giving the government an even larger role in health care.

Obama pumped health care allies and skeptics alike for ways to overhaul the costly and frustrating system during a White House summit this month. He heard only applause and agreement when he told them there's "a clear consensus that the need for health care reform is here and now."

However, he conceded that opinions vary widely on what to do and said that winning quick approval for historic and stunningly expensive legislation won't be easy.

Still, the unanimity on the urgency to act underscored how the political environment has become more favorable to revamping the thorny system since President Bill Clinton's attempt failed in the 1990s under intense resistance from drugmakers, insurance companies and others. All those interest groups were on hand at Obama's summit, and the president intended his Washington session and a series of meetings to follow across the country to signal that his push for universal health care coverage will be more open and inclusive than Clinton's.

"Every voice has to be heard," Obama said. Mindful of the demise of the Clinton plan, Obama warned, "Those who seek to block any reform at all, any reform at any cost, will not prevail this time around."

The U.S. system is the world's costliest; the country spends some $2.4 trillion a year on health care. It leaves an estimated 48 million people uninsured, and many others lack adequate insurance.

Although Obama wants coverage for all, the president has suggested a willingness to compromise. That, too, is a break from Clinton's posture in the 1990s when he promised to veto any health care measure that didn't give him what he sought.

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